Susceptibility-weighted imaging: current status and future directions.

Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.

Database integration of protocol-specific neurological imaging datasets.

For many years now, Magnetic Resonance Innovations (MR Innovations), a magnetic resonance imaging (MRI) software development, technology, and research company, has been aggregating a multitude of MRI data from different scanning sites through its collaborations and research contracts. The majority of the data has adhered to neuroimaging protocols developed by our group which has helped ensure its quality and consistency. The protocols involved include the study of: traumatic brain injury, extracranial venous imaging for multiple sclerosis and Parkinson's disease, and stroke. The database has proven invaluable in helping to establish disease biomarkers, validate findings across multiple data sets, develop and refine signal processing algorithms, and establish both public and private research collaborations. Myriad Masters and PhD dissertations have been possible thanks to the availability of this database. As an example of a project that cuts across diseases, we have used the data and specialized software to develop new guidelines for detecting cerebral microbleeds. Ultimately, the database has been vital in our ability to provide tools and information for researchers and radiologists in diagnosing their patients, and we encourage collaborations and welcome sharing of similar data in this database.

Assessing global and regional iron content in deep gray matter as a function of age using susceptibility mapping.

PURPOSE: To investigate the correlation of non-heme iron content in deep gray matter nuclei as a function of age using quantitative susceptibility mapping (QSM) from both whole-structural and regional perspectives. MATERIALS AND METHODS: We studied a group of 174 normal subjects ranging from 20 to 69 years old and measured the magnetic susceptibility of seven subcortical gray matter nuclei. SWI (susceptibility-weighted imaging) phase images were used to generate the susceptibility maps, which were acquired on a 1.5T scanner. The 3D whole-structural measurements were used to determine age-related thresholds, which were applied to calculate the local iron deposition (RII: portion of the structure that contains iron concentration larger than the structure threshold). Age-susceptibility correlation was reported for each measured structure for both the whole-region and two-region (low iron and high iron content regions) analysis. RESULTS: For the local high iron content region, a strong age-susceptibility correlation was found in the caudate nucleus (CN,R = 0.9), putamen (PUT,R = 0.9), red nucleus (RN,R = 0.8), globus pallidus (GP,R = 0.7), substantia nigra (SN,R = 0.5), and pulvinar thalamus (PT,R = 0.5); for the global iron content, a strong age-susceptibility correlation was found in CN(R = 0.6), PUT(R = 0.7), and RN(R = 0.6). Overall, for each structure analyzed in this study, regional analysis showed higher correlation coefficient and higher slope comparing to the whole-region analysis. Further, we found the quantitative conversion factor between magnetic susceptibility and iron concentration to be 1.03 ± 0.03 ppb per µg iron/g wet tissue. CONCLUSION: We conclude that the age-susceptibility correlation can serve as a quantitative magnetic susceptibility baseline as a function of age for monitoring abnormal global and regional iron deposition. A regional analysis has shown a tighter age related behavior, providing a reliable and sensitive reference for what can be considered normal iron content for studies of neurodegenerative diseases. J. Magn. Reson. Imaging 2016;44:59-71.

MR imaging of the yucatan pig head and neck vasculature.

PURPOSE: To evaluate the cerebral venous drainage system of the swine as a probable model to test whether extracranial venous abnormalities may play a role in neurodegenerative diseases as reported recently in multiple sclerosis. MATERIALS AND METHODS: Three Yucatan micropigs, 5 to 7 months old, were scanned with a comprehensive MRI protocol at 3 Tesla. The vascular anatomy of the head and neck was imaged using conventional and angiographic MR sequences. Phase-contrast MR images were collected at multiple levels of the neck and intracranial space to monitor flow. RESULTS: Three large cervical veins were observed; the external jugular vein draining the olfactory and gustatory tissues; the internal jugular vein (IJV) draining the cavernous sinus as well as surrounding soft tissues in the neck; and the ventral vertebral venous plexus (VVVP) surrounding the dural sac and paraspinal region. The majority of the cerebral blood flow in the pig appears to drain through the VVVP. Flow through the IJV comprised a nondominant component. Anastamoses were observed connecting the major veins of the neck bilaterally. CONCLUSION: The dominance of outflow from the brain to the VVVP may be analogous to the typical dominance of the IJVs in humans in the supine position.

Correlation of putative iron content as represented by changes in R2* and phase with age in deep gray matter of healthy adults.

PURPOSE: To establish a correlation between putative iron content using susceptibility weighted imaging (SWI) phase and T2* weighted magnitude values in the basal ganglia and the thalamus as a function of age in healthy human brains. MATERIALS AND METHODS: One hundred healthy adults (range, 20-69 years; mean, 43 years) were evaluated for this study using a gradient echo sequence. The original magnitude and high pass filtered phase data were analyzed as proxy variables for iron content in the substantia nigra, red nucleus, globus pallidus, putamen, caudate nucleus, thalamus, and pulvinar thalamus. Each structure was broken into two parts, a high iron content region and a low iron content region. RESULTS: Both magnitude and phase data showed an increase in putative iron content with age. However, the high iron content region revealed two new pieces of information: both the average iron content per pixel and the area of high iron increased with age. Furthermore, significant increase in iron uptake as a function of age was found past the age of 40. CONCLUSION: A two region of interest analysis of iron is a much more sensitive means to evaluate iron content change over time. Contrary to the current belief that iron content increases level off with age, the putative iron deposition in the high iron content region is seen to increase with age.

Evaluation of machine log files/MC-based treatment planning and delivery QA as compared to ArcCHECK QA.

PURPOSE: A treatment planning/delivery QA tool using linac log files (LF) and Monte Carlo (MC) dose calculation is investigated as a standalone alternative to phantom-based patient-specific QA (ArcCHECK (AC)). METHODS: Delivering a variety of fields onto MapCHECK2 and ArcCHECK, diode sensitivity dependence on dose rate (in-field) and energy (primarily out-of-field) was quantified. AC and LF QAs were analyzed with respect to delivery complexity by delivering 12 × 12 cm static fields/arcs comprised of varying numbers of abutting sub-fields onto ArcCHECK. About 11 clinical dual-arc VMAT patients planned using Pinnacle's convolution-superposition (CS) were delivered on ArcCHECK and log file dose (LF-CS and LF-MC) calculated. To minimize calculation time, reduced LF-CS sampling (1/2/3/4° control point spacing) was investigated. Planned ("Plan") and LF-reconstructed CS and MC doses were compared with each other and AC measurement via statistical [mean ± StdDev(σ)] and gamma analyses to isolate dosimetric uncertainties and quantify the relative accuracies of AC QA and MC-based LF QA. RESULTS: Calculation and ArcCHECK measurement differed by up to 1.5% in-field due to variation in dose rate and up to 5% out-of-field. For the experimental segment-varying plans, despite CS calculation deviating by as much as 13% from measurement, Plan-MC and LF-MC doses generally matched AC measurement within 3%. Utilizing 1° control point spacing, 2%/2 mm LF-CS vs AC pass rates (97%) were slightly lower than Plan-CS vs AC pass rates (97.5%). Utilizing all log file samples, 2%/2 mm LF-MC vs AC pass rates (97.3%) were higher than Plan-MC vs AC (96.5%). Phantom-dependent, calculation algorithm-dependent (MC vs CS), and delivery error-dependent dose uncertainties were 0.8 ± 1.2%, 0.2 ± 1.1%, and 0.1 ± 0.9% respectively. CONCLUSION: Reconstructing every log file sample with no increase in computational cost, MC-based LF QA is faster and more accurate than CS-based LF QA. Offering similar dosimetric accuracy compared to AC measurement, MC-based log files can be used for treatment planning QA.

The role of venous abnormalities in neurological disease.

The role of the venous circulation has long been underestimated in clinical practice and in research into neurological diseases. In this review, we present an overview of the existing evidence that venous abnormalities can play a key role in the development and manifestation of neurological and neurodegenerative diseases. We review the history behind the role of venous diseases in multiple sclerosis and their connections with the disease landmarks, the links of chronic venous hypertension to cerebral hydrodynamics and the role of iron in MS. In addition, we highlight the role of venous abnormalities in other diseases including jugular venous reflux, developmental anomalies, hydrocephalus and cerebrospinal fluid flow. Finally, and based on the information presented throughout the whole review, we conclude with the link between chronic cerebrospinal venous insufficiency and MS and the role and power of magnetic resonance imaging in diagnosing venous anomalies.